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Pediatric stentless pyeloplasty: A 10-year single-institution, multiple surgeon experience
Ioana Fugaru, MD, Nick Daskalakis, Medical Student, William R. DeFoor, MD, Brian VanderBrink, MD, Pramod Reddy, MD, Eugene Minevich, MD, Andrew Strine, MD, Michael Daugherty, MD.
Cincinnati Children's, Cincinnati, OH, USA.
BACKGROUND: Robotic pyeloplasty (RP) in children is a commonly performed procedure. Placing an internal ureteral stent across the anastomosis at time of reconstruction is commonplace. Performing a stentless RP has the potential to reduce patient discomfort in addition to obviating the need for a second anesthetic for extraction. We compared the outcomes of patients undergoing RP over a 10-year period with 5 different robotic surgeons at a single institution.
METHODS: A retrospective study was performed for all patients undergoing primary RP for unilateral renal pathology from January 2015 - February 2025. Only patients with internalized stents were included in the stented cohort. Stentless patients did not have any internalized JJ tubes, externalized nephrostomy tubes nor other drainage tubes. At our institution, we frequently use high-dose dexamethasone (HDD) intraoperatively in stentless cases with the aim of reducing anastomotic edema. The decision of stenting and using HDD was at the discretion of the surgeon. We compared patient characteristics, complication rate/grade, ER visits/readmissions at 30 days and dexamethasone dosage between stented and stentless RP.
RESULTS:A total of 272 patients underwent RP and met inclusion criteria. There were 191 males (70.2%) and 81 females (29.8%). A total of 164 left-sided RP were performed (60.3%). 137 (50.4%) cases were performed stentless. Patients undergoing stentless RP were noted to be younger (9 vs 48 mo; p=0.0058). Stentless RP was shorter than stented RP (169 min vs 193 min; p=0.014). There were similar rates of ER presentation in both groups (p=0.0904). Of the stentless cases, 3 patients (2.2%) required stenting post-operatively due to complications. Stentless patients had an overall lower rate of any complications at 30 days (13.1 vs 28.9%; OR 0.25; CI 0.13-0.52; p=0.0002), most of which were Clavien-Dindo 1/2. Stentless patients who received HDD had less ER visits/readmissions at 30 days than stentless patients without HDD (3 vs 18%; OR 0.14; CI 0.04-0.58; p=0.0058).
CONCLUSIONS: A stentless pyeloplasty at our institution appears to be a transferrable procedure with high efficacy and low complication rates amongst multiple surgeons at our institution. Perioperative factors such as higher dose steroids may potentially mitigate acute post operative complications.
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